Reintroducing Foods after Following the Autoimmune Protocol

The Paleo diet autoimmune protocol is an elimination diet designed to reduce inflammation, decrease production of autoantibodies and heal the gut. The most expedient way to see improvement is to follow the autoimmune protocol very strictly at least for a month (although there are other options, discussed in this post). Most people will see some improvement in their symptoms over that time (those that do not see noticeable improvement may wish to consider food sensitivity testing and also watch out for foods with a high likelihood of gluten cross-reactivity). Many people are then eager to start reintroducing the restricted foods. This post is designed to guide you through that process.

So, first, let’s talk about how you will know that you are ready to start reintroducing some foods.I suggest waiting until you see improvement in the symptoms of your disease (this will be highly individual). You should see at least some improvement in your symptoms within one month of following the autoimmune protocol (for some, it may take as long as three months to notice improvement). As you continue to follow the autoimmune protocol, you should continue to see improvement, although it may be slow (see this post for why) and some people may not experience full remission of their disease until they have followed the autoimmune protocol strictly for many months or even several years. Unfortunately for some, permanent damage may mean that a full recovery is not possible. In the case of aggressive and destructive autoimmune diseases, the autoimmune protocol will still help slow and perhaps halt the progression of the disease, even if meaningful improvement is not possible.

It is your choice whether to wait until you see some improvement of your symptoms or to wait until you have fully healed before reintroducing restricted foods. How you feel is the best gauge and only you will know if you are ready. A word of caution though: don’t let missing foods drive this decision; it really should come from feeling good and seeing improvement in your disease.

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If you have been following the autoimmune protocol strictly for a period of months without improvement, there are two options. You may need to follow additional vegetable restrictions (see this post on FODMAPs and this post on SIBO). I also suggest considering food sensitivity testing as you may be continuing to consume a food to which you are sensitive. You may find the book Practical Paleo a tremendous resource because Diane Sanfilippo outlines a variety of supplements which can help speed healing for those with leaky gut and autoimmune disease. I have also invited a number of alternative healthcare professionals to provide their take on the benefits of the services they provide (naturopathic physicians, chiropractors, acupuncturists, and physical therapists), which may be a good option for you. And of course, working with a food-savvy medical professional can also be exceedingly helpful.

Once you have decided to reintroduce foods, I suggest reintroducing from least likely to cause issues to most likely (I’ll order the foods below). When you reintroduce a food, consume only a small amount of that food, at least twice on two consecutive days. Reintroduce one food at a time, giving at least 3 days in between reintroduction before trying the next one (this is even true for seed-based spices). If you have a violent reaction to a food, you will have to wait a couple of weeks for your immune system to calm down before reintroducing the next food.

What should you look for to determine if you can continue to consume this food? Even one of the following symptoms is enough to stop eating that food. You can always try again later in case the symptom was a coincidence. Also, even if you cannot tolerate that food now, as your body continues to heal, you may be able to in a couple of months. Symptoms to watch for:

What order should restricted foods be reintroduced? I have classified foods from lowest to highest likelihood to be problematic. Start with the lowest and work your way up. Within each category, just pick the food that you miss the most. If you have had food sensitivity testing done, leave any foods you have a diagnosed sensitivity for last (or perhaps before nightshades).

I have successfully reintroduced egg yolks, seeds, and nuts except almonds, grass-fed butter, cocoa, and starchy vegetables (as long as I keep the dose of all of these things low). I understand well how reintroducing just these few foods can feel like a huge improvement to my quality of life. I hope that you also find at least some foods that can be successfully reintroduced! Good luck!

About Dr. Sarah Ballantyne, PhD

Award-winning public speaker, New York Times bestselling author and world-renowned health expert, Dr. Sarah Ballantyne, PhD (aka The Paleo Mom) believes the key to reversing the current epidemics of chronic disease is scientific literacy. She creates educational resources to help people regain their health through diet and lifestyle choices informed by the most current evidenced-based scientific research.

Reader Interactions

Comments

Hi! My husband has been doing the AIP for about 45 days and wants to reintroduce egg yolks (has not tried to reintroduce any foods yet). This may be a silly question, but is there a good way to ensure that there are no egg whites when separating the egg? I would think a small amount of egg white might remain on the yolk part.

My husband’s reason for doing the AIP (we’ve been strict Paleo for about a year now) is that he has pretty severe psoriasis (has had for about 4 years now) and joint/back pain (7-8 years). Do you think it’s wise to try to reintroduce egg yolks (and he’s dying to get ghee back in if possible) at this point? He has had about 75% less joint pain, but has not yet seen an improvement with his psoriasis.

Yes, I think trying egg yolk and ghee is appropriate (these particular foods have more to do with sensitivities than anything else). With the psoriasis still bad though, I would be very cautious with egg whites, nightshades and even tree nuts.

I sepearatly my eggs in my fingers, pinch off the white stringy bits, and then gently rinse the egg told to remove any leftover whites. It works for me (but I can tolerate very small amounts of egg white).

Could you tell me what you mean by ghee and egg yolk are more about sensitivities? I am about 2 months into strict AIP and am trying to reintroduce ghee today. Does that mean I might have symptoms but it wouldn’t affect my healing process? Thanks!

I mean that the problems with those foods are just the high rate of food sensitivities to them, not some other proteins or compounds that stimulate the immune system or damage the gut. So, if you don’t have a food sensitivity to them, they are great nutrient-dense foods. If you have symptoms though, don’t continue.

Dear Sarah,
Thank you so much for this post. It is really valuable for people who have to do the AIP and reintroduce then some foods. And I have a question, I would like to know more about the reasons of the order of least problematic to the most problematic foods. Where could I read more about it?

The order isn’t based on statistics so much as what I know about how these foods affect the immune system. If you slick on the links of each of the foods that have one, it will take you to posts I’ve already written explaining why each one can be a problem.

Do you mean coming from at autoimmun eprotocol perspective or a healthy individual perspective? I think a healthy individual could experiment with all of those foods. Polished white rice is probably the least potentially problematic of all the grains and pseudo grains. I actually make rice occasionally for my husband and kids. I also occasionally buy raw, grass-fed cheese for them. I think that healthy people, who don’t have issues with dairy can benefit from it, especially grass-fed. I suggest that healthy people try 3-4 weeks without those foods when they first adopt a Paleo diet and then try reintroducing one at a time to see how they do. For reintroducing dairy, I suggest butter, then cream or fermented dairy, then other dairy. When you peel and cook potatos, you remove the majority of the glycoalkaloids, so again, healthy people can usually handle them.

For those recovering from autoimmune disease, it’s a bit of a different story, but the foods could be attemptd if the individual’s disease goes into remission. If dairy fat and fermented dairy are successfully reintroduced, cheese or milk could be tried (they are generally more problematic for those with sensitivities/allergies or those with leaky guts, but once the gut has healed many people do well with them). Whit rice may also be tolerated. I’m a little more hesitant to recommend trying potatoes and would only suggest that is tomatoes are successfully reintroduced. Also, all of these foods are highly insulinogenic, which can increase inflammation, so again, extreme caution should be taken.

Thanks for your thoughts. My instinct suggests that for those managing an autoimmune condition, nightshades–including white potatoes–are more problematic than nonfermented dairy or even white rice, despite the fact that white rice is more insulinogenic than nightshade vegetables. I was heartened to see that tomatoes are *last* on your list. I have the suspicion that tomatoes, potatoes, peppers, and eggplant may be off my menu for good, even in small quantities. Dairy seems to be less problematic. And white rice may be one of those foods that a (healing) autoimmune condition can tolerate in small amounts, eventually: it’s useful to know that for times when one is a guest.

I think that once there are good indications that the gut has healed, occasional legumes are fine (maybe no more than 1-2 times per week). They are always better if soaked before cooking. I would stay away from peanuts though, completely. And I would only suggest soy if it is fermented.

We’re finding there is a difference in legumes for us – on the okay list are split peas, white pea beans, and black beans. Lentils would probably be fine, but often are cross contaminated with gluten. These, apparently, are SCD legal once the gut is healed as are kidney beans (which we don’t eat due to IgG reactivity).

My guess is it’s probably 50:50 in that approximately 50% of people that are gluten sensitive are also dairy sensitive. I can tolerate pepper more than tomatoes or potatoes and cannot tolerate non-fermented. We seems to be okay with 24 hour fermented yoghurt and well fermented cheeses, but milk is a huge problem. I think white rice is okay, particularly in a congee type dish if you do not have blood sugar issues.

Awesome post Sarah! We’re in the process of getting micronutrient testing done on our oldest. Spectracell labs is the company and it is available to Canadians. I’m hoping correcting deficiencies before reintroduction of problematic foods will help. Chris Kresser is reserving judgment on the test. Have you heard anything else about it? Thanks

I’m confused by the parenthetical remark in the bullet “Starchy vegetables if you have been avoiding them (except tapioca/cassave/yucca)” Do you mean to say that tapioca/cassava/yucca should not be re-introduced? Or do you mean that there is no need to eliminate them in the first place?

I have a question about determining how much of a particular food you can eat. Specifically, after my disease having been in remission for a few months, I reintroduced grass-fed yogurt and milk following the protocol you specified (two times a day for two days, in small portions, wait three days). All of that was fine and my disease (Hidradenitis suppurativa) did not return. Then I went on vacation and decided to try eating dairy normally as I was away from home. So basically 1 to 2 servings a day, and not grass-fed (or probably even organic). After four days of eating this way, I had an autoimmune reaction that now has lasted about 10 days and isn’t yet going down in inflammation (although I have returned to a strict Paleo diet; the AIP isn’t necessary, I’d already introduced those foods and hadn’t had a problem eating them regularly).
Anyhow, I guess my question is two-fold: any idea how long it will take until the inflammation calms down again and what I can do to help it? And secondly, is there another step in the AIP for determining the amount that you can eat of a specific food (you often say on your site, for example, that you know you can have X in a small quantity — how did you figure that out?)
Many thanks!!

The problem could very well be the difference between grass-fed and conventional dairy, or could be related to how much you were consuming. There’s really no way to know how long your current flare will last, but you might consider going back to the AIP to get things under control and then reintroduce to the standard Paleo diet as you did before. I think the only way to find a line with food is to slowly increase how much you eat and notice when you start to have symptoms. If you pull it out completely do those symptoms go away. For me, I have issues even with one bite of eggs but can have about a handful of nuts and seem okay… But if I eat a big bowl of nuts then I have skin issues. The best explanation is that I probably have a food sensitivity to eggs but not nuts. With nuts, it’s probably just the phytic acid and omega-6 content, so I can handle a little but too much causes inflammation. In this way, it depends on what the food is too. You mght not notice much of a reaction until you get the amount higher, but it doesn’t go away when you reduce the amount. That just means you’ve hit the threshold to see symptoms but really you shouldn’t eat that food. If you reduce the amount and the symptoms go away, then you’ve figured out how much you can tolerate. I’m sorry there isn’t a more straight forward way to test thing, but I hope this helps anyway.

Hi,
Thanks for your quick reply. I don’t understand though why going back to the AIP would make a difference? If I tolerated all the foods on the AIP after reintroducing them and eating them regularly for 3 months now why would my body start reacting to them?
Thanks again for your help!

The AIP is the most efficient way to reduce inflammation. Once your inflammation is back down, then you will probably tolerate all the same foods again. You might not even need to do the full AIP for very long, maybe just a week, and you can probably be more cavalier about reintroduction than you were the first time around. But if conventional dairy has made your gut leaky again, you might be having issues with eggs or tomatoes etc. so it’s best for healing to cut those out.

Very helpful info for me too. You are helpful to so many people. I am really grateful for all you do for this community of sufferers who are searching for help.

I have been reintroducing foods successfully and unsuccessfully for a couple of months now. This week I made rice pudding (arborio rice and whole RAW milk, freeze dried vanilla–baked for 3 hours). I tolerated it very well UNTIL I ate too much yesterday. It caused severe stomach cramps and pain. Darn. Guess I passed the threshold you mentioned. I will go back to AIP for a while as you recommended for Sally. Thanks.

Question: after 7 months on AIP and after several food reintroductions I developed eczema under one eye (it was either after cashews or almonds) I can’t seem to get it under control. I have never had eczema before the AIP. Any ideas as to why it would happen now? I ate the same foods before AIP and never had eczema. It is bewildering.

As you pull out foods that you are sensitive to, the cells that help regulate immune reactions to those foods die off faster than the cells that are doing the reacting. There’s this weird in between phase, which can last up to a year, where you have even bigger reactions to those foods because the cells that are doing the reacting are still there, but the ones that would normally help keep the reaction relatively controlled aren’t. Focus on fat-soluble vitamins and lots and lots of sleep.

Sarah, I’m curious why you suggest eating the food for 2 consecutive days, when most elimination diets have you reintroduce the food for one day only (and then wait 72 hours for a reaction). Can you explain? I’ll be reintroducing foods this week and am trying to decide which method to choose.

Sometimes the first bit of eating it won’t cause a reaction by itself but primes the immune system and then you react the second time. I suggest eating it two days in a row to guarantee that you don’t miss a reaction if there is one.

Thanks so much for the information- it is all very helpful! I have celiac disease, arthritis and SIBO- the autoimmune Paleo diet really helps me to manage my symptoms. I am also curious if (at some point) you could share more about foods high in oxalates. After my own investigation/elimination trial- I am wondering if foods high in oxalates may be a problem for me. However, the oxalates lists I find online all seem to all be different!

Oxalates are interesting. They actually haven’t been able to confirm the existence of oxalate sensitivity (although I think that if foods bother you, you shouldn’t eat them whether its a confirmed sensitivity or not). And, there are studies that show that high oxalate diets actually improve gout (even though conventional treatment of gout is to avoid oxalates). I do talk about them in my book, but I’m not sure it’s a section that lends itself well to a teaser excerpt. I’ll see if I can pull together a post on it later in the summer.

I am curious to know how long you did the full AIP before reintroducing foods successfully ? 🙂
I also read somewhere that you found it hard to skip coffee…did you notice a big improvement when you cut it out ?

Btw I LOVE your blog and can’t wait for your new book to come out!
– Disa

Maybe 6 months before I was able to start handling some eggs and nuts (as long as I don’t eat them daily or eat too much at once). I think I’ll probably never be able to eat nightshades or chocolate. And I still haven’t tried coffee since my stress level is still so high with the book, but I will once it goes to printer.

I have a question about pregnancy, AIP, and food reintroductions. I have been following the AIP for 8 weeks and am also 8 weeks pregnant. I started the AIP because I have struggled with leaky gut, fatigue, depression/mood swings, constipation, bloating, acne, and hypothyroidism (not Hashimoto’s, just hypothyroidism) for several years. I’m hoping to start food reintroductions soon, but even though I’ve seen a lot of improvements in my symptoms, I still experience bloating, constipation, and fatigue sometimes but am not sure what foods might be causing it? Or if those are just pregnancy symptoms? Since pregnancy affects the immune system so much and also usually brings fatigue and digestive discomforts with it, will I really be able to find success with AIP and be able to accurately do food reintroductions while pregnant? Please help! I am feeling really discouraged.

Yeah, all of those things can be caused by the hormones of pregnancy, so you’re right that it might be more difficult to judge reactions. If you had an overt/diagnosed autoimmune disease, I would urge you to consider sticking with the AIP (or AIP with grass-fed ghee and pastured egg yolks added) throughout pregnancy (since the chances of a flare after your baby is born is so high). Since you have symptoms that may or may not be related to an autoimmune disease, I think reintroductions should be fine (if a food really isn’t working for you, you’ll probably still know even with all the “side effects” of pregnancy). I still recommend focusing on the most nutrient dense foods available to you. And also keep AIP in mind if your symptoms return after your baby is born (or after they wean, which causes another hormone shift and can cause autoimmune flares).

First, I would like to thank you for all of the help your blog and podcast have been to me in my AIP journey. I simply cannot wait to get my hands on your new book – AND – the cookbook!

My question involves re-intro of foods, namely, coffee. My doctor says that I have a TH2 (I hope I have that right) dominant system and coffee, green, oolong and white teas are immune stimulators and, while actually healthy for some people to enjoy, are off limits for me.

I’m having a super hard time dealing with that. I adore coffee – though I’m not an every day cuppa joe gal. I like the indulgence of a coffee latte (with coconut milk and a pinch of chocolate) and miss being able to enjoy coffee when we have friends over for dinner.

Is this the sort of thing that an occasional splurge would warrant – or is it the sort of thing that’s going to wreak havoc on my body?

Tests just confirmed I have “autoimmune reactivity” of the kind involving phospholipids. The doc said I need to take it seriously as it effects not just one organ, but every cell in my body, thereby having a systemic effect. He also let me know that AIP (with tolerated food introduction) needs to be a way of life for me.

Aw, thank you! I’ve had some angry emails over the news that the book is split in two, so its nice to know that someone is excited!

The whole Th1 Th2 balancing idea is outdated. We now understand that the adaptive immune system is far, far more complicated than that and that the much bigger effect is providing the necessary nutrition needed to support regulatory T cell function (stress management and sleep factor in very critically here too). Certainly, there are some immune stimulating effects (especially green tea extract, which is clearly mich more powerful than a cup of green tea), but the bigger effect is going to be nutrients, supporting a healthy gut, and regulating hormones (like cortisol). I certainly wouldn’t recommend a daily cup of coffee (for anyone with autoimmune disease due to studies showing that its pro inflammatory), but I think an occasional cup, if you feel okay afterward and it doesn’t affect your ability to manage stress or disrupt your sleep, should be fine. Green and black tea have been shown to lower cortisol responses due to stress (coffee magnifies it), so I think you could experiment with how you feel with a cup of tea every day, again being mindful about how it makes you feel.

Thank you so much for responding to me!! I’m so relieved at even the thought of trying out the coffee and tea. My favorite tea is an oolong blend that my sweet hubby and kids specially order for me from St. Simons Island, GA and he had just loaded me up with it when doc said “NO” to the oolong. It was just a small enough amount of caffeine to perk me up, but not enough to give me that afternoon crash. I will start slowly though, perhaps even after introduction of foods is complete.

Please don’t let the angry emails get you down! You’ve given such an important service to the autoimmune community by your blog, podcast and now upcoming book – that many of us are beyond excited. I’m telling everyone I can about them coming up as I know they will be such a blessing to so many who are trying to navigate this journey to healing. AND I’m actually relieved the cookbook is going to be separate as I seem to use them more if they’re not “in the back” of a book. It can be an easy reference for me in my kitchen…where I seem to live…

I notice that you don’t mention potatoes at all on this list. What would be your suggestion as to when to trial them? Around the same time as eggplants, perhaps?

I am also not at all unhappy that the book will be split in two, so boo on those angry emails! Yes, it is a bummer for us “early adopters” who are in the midst of sorting this out without having a comprehensive resource, but I’m glad that future autoimmune sufferers will have a great sciencey book AND a complete cookbook.

I would suggest including them at the same time as as chili peppers. And definitely better to peel them.

And thank you for your support! I really think it was the right decision compared to cutting out more than half the material. And I’m working on some other great resources to launch late this year or early in the New Year which should be very helpful for people too. 🙂

This all is such an interesting process. I’ve been Paleo almost 3 years, but just did the AIP version (mostly taking out eggs, since I didn’t eat much of the other things) for 33 days. I did a reintroduction of egg yolks a couple days ago that mostly went ok, then stopped for a couple days to monitor any long-term reactions. Finding none, I had egg yolks for breakfast this a.m. and had to rush home a few hours later with severe intestinal difficulties! I find this so weird since I was eating eggs regularly pre-AIP. I want to tell myself it is all a coincidence, but even I’m having a hard time believing that!

I wanted to first thank you for all your advise! It has been greatly appreciated!! I am struggling with the AIP right now. I have Celiac Disease and eczema. I am hoping with doing the AIP will be helpful with finding out my triggers for Eczema. I am on day 17 of the AIP. I am 6 weeks pregnant with sever nausea, serious smell sensitivities, and fatigue.It seems like everything I eat each day, I am disgusted at the though or smell of it the following day. This is every much limiting my food choices. I was curious if you would recommend me starting to add other things back into my diet. I am craving eggs and cheese. I know for sure that the dairy isn’t my trigger for eczema since I was dairy free for 8 months and my symptoms didn’t go away. So it would be nice to add a little cheese back into my diet. Pre AIP I didn’t eat a lot of dairy anyways. I am trying to listen to my body with this pregnancy and heal it at the same time since my eczema has gotten so bad. Any suggestions would be helpful. I am struggling so that I just want to cave and I know that isn’t good.

Cutting a food out and not seeing symptoms go away isn’t a guarantee that that food isn’t a trigger (it just means that there’s still a trigger in your diet or lifestyle). But, I think that cautiously trying some nutrient-dense foods you wouldn’t normally eat if you are craving them is worthwhile. See if you can stick with pasture-raised and grass-fed if at all possible.

Hi Shanna, I’d love to know how your pregnancy and AIP turned out for you. I’m now in a similar boat; 6 weeks along and have been AIP for 4 months but really losing my appetite and unable to eat very many things twice. Also craving foods I craved in past pregnancies like Mexican food (the spices! The corn! The cheese!) and actually egg yolk, which I could go ahead and try to reintroduce. I’ve done so well honoring my body with this healing diet but am afraid pregnancy nausea will undo me! Any advice? How’d you fare? Thanks!

Just found your post since I was recently diagnosed with lichen planopilaris. Similar to “planus”, but it affects the scalp with itchiness, inflamation & permanent hair loss. Very stressful which doesn’t help. Starting the aip and hope to see and feel improvement. Don’t have any pain whatsoever so I guess that’s a good thing, but sometimes I think I could deal with pain more than the hair loss. Have you come across anyone else with this autoimmune disorder. You’re story is very inspiring and I’m hoping I will have the same ending. Thank you so much for doing what you do!

Yes, although only people who have reported initial experiences on the AIP (I’m guessing the lack of follow-ups is a good sign). Similar to other skin disorders, sleep, stress management, lots of glycine-rich foods, long-chain omega-3s, vitamins A & D are especially critical.

Um, the real answer is I’m not sure. I’ve never heard of anyone having a fever as a reaction (extreme muscle pain, yes), but I think it would be possible since the glycoalkaloids and lectins in some nightshades (especially tomatoes) are such good adjuvants (immune stimulators), kindof the same way you might get a fever from a vaccine…. but this also would assume that there’s some other antigen around (virus, bacteria, parasite, food allergy or intolerance…). I do think it’s much more likely a badly timed virus though.

I am on my last food group to introduce (nightshades), and I see I missed this very importing post! I read on another site that you should eat a bunch of the offending food for 24 hours then wait 3 days, so that is what I was doing. Most things I did fine on until the end of the day, plus I was fine for the following 3 days (dairy was the exception. Grrr.). For instance, 5 eggs I was good, (plus Paleo bread with egg whites) but after 6, I started belching for the next 30 mins or so. (Yes that is a lot of eggs – I never eat that much!) It looks like I need to go back and retest a bunch of stuff slower. I guess I am lucky in that my problems are very minor. Any changes I have had have been very subtle, so I am retesting several things anyhow just to make sure it wasn’t coincidence.

Just to verify for myself and others, you feel that some non-AIP foods are fine in moderation if tolerated? For instance, one may (*may*) still be OK with an egg or 2 a day (but not 6!)? Or maybe an egg a few times a week. This would also imply that one would need to find their own personal ‘tipping point’ and not exceed it. Am I understanding this correctly?

I know, you are busy with your book tour But I have a few more questions:
1) How do you know if intestinal gas is OK or bad? Some foods naturally cause gas, foods that we are encouraged to eat (like broccoli) and, while some ‘bad’ reactions are obvious, others I am not so sure if they are causing a problem or not. I know I have burning in my stomach (left side under ribs) since I started the AIP, but that seems pretty normal for me when I increase meat/protein consumption (Doesn’t seem to matter the source – which is why I was bummed about dairy & eggs! Veggies I’m good on, but I’m not a huge meat eater.).
2) Why is fish & shellfish not eliminated since it is a common allergen? I know you added nuts to your AIP just because a lot of people react to them
3) I saw you had a pay pal donation link. I am not sure what way I am going to go next (double checking somethings I may have reacted to) but I want to compensate you one way or another for your help. Do you have a suggested donation amount? What are you going to charge for your consults?

Any symptoms at all, including gas, can indicate food intolerance. If it is excessive or bothersome, you may consider looking into FODMAP intolerance: https://www.thePaleomom.com/2012/08/modifying-Paleo-for-fodmap-intolerance.html. I would also look into taking HCl for the burning that happens after eating meat. Fish and shellfish are extremely nutrient-dense, whereas nuts and seeds are not. Sarah appreciates donations of any amount, and the consulting website with a list of prices will be live soon. – Christina, Sarah’s assistant

Hello! I am curious as to why a craving indicates a reaction. I recently reintroduced some dairy and holy cow was I craving chocolate! As soon as I took the dairy back out I was not craving chocolate, or at least not with the same ferocity 😉 Thanks!

We’re following the AIP protocol and started low fodmap. When we reintroduce the high fodmaps back do we need to do it one at a time waiting the 3 to 7 days for each food or can we add more than that back at a time? I’d like to add the sweet potatoes and avacados back asap ( my husband is at the low end of a healthy weight, per you book, and we’re trying to keep the weight on and keep him feeling full). Do you have any suggestions for folks needing to keep or gain weight on the protocol?

Also, I’m so appreciating the charts in your book. It’s really helped add some variety to our diet and encouraged me to try foods I wouldn’t ordinarily think of…I like how you have the food organized in the chapter with the green tabs–I went to check on turmeric today and it was so easy to find the info I needed. (And yay–something legal to spice up the turnip and jicama fries! My husband thought I’d forgotten and put cayenne on them!)

My psoriasis has COMPLETELY DISAPEARED and I’ve only been following the AIP för 18 days! Is this even possible? It’s always been limited to my scalp and at the most (18 Days ago) covered 50 % of the surface. Do you think it is safe to start reintroducing foods already? This feels too good to be true 🙂

i’ve been on strict AIP for 4 months and have decided it’s time to try some reintroductions. however, i have a completely different situation than any stories i can find online.

i have alopecia areata and therefore can’t feel or see my symptoms…no gastro or skin issues or anything else really. i feel great and always have felt great after eliminating gluten and adopting a Paleo-like diet a few years ago. i’m very lucky.

but, i can’t feel my hair fall out and i can’t feel it regrow. i take pics of the top and back of my head but it isn’t the same as being able to look closely plus any changes one way or the other happen very sloooooowly.

i jumped on AIP immediately upon discovering my AA because of the assumption i have leaky gut plus i want to hopefully prevent other AI conditions from developing.

SO i obviously won’t be able to monitor the symptoms of my disease during reintroduction. i’ll watch diligently for any/everything else including the items in your list above. my doc says it’s possible i will be able to be sensitive to (have an inflammatory response to) some of the foods eliminated on AIP that i will be reintroducing without me having ANY discernible symptoms whatsoever.

Usually, after elimination, you are able to notice reactions more easily. Literally any change in your health could be attributed to a food reaction. For example, I found that some types of dairy give me hiccups. You never know what you’ll find until you try. If you don’t notice any symptoms, then the food should be fine. – Christina, Sarah’s assistant

I have been following the AIP protocol for one month and already seeing the rewards,
but there is one area I am unsure of, as a woman aged 67 I am concerned about calcium, how do i get enough calcium? I have continued supplementing until I work it all out and I also take fish oil that includes Vitamin D. Dawn Haines Adelaide South Australia

This is great information! I’m curious about reactions during the reintroduction phase. I am finding that the first time I eat something, I react strongly (ex: all nuts cause neuro symptoms). But if I eat a small amount of it again and again the reactions lessen quite a bit. Why does that happen? My body tends to over respond to lots of things but will stop reacting if I get used to something. Is it still best to avoid those triggers or is it ok because my body is learning that it doesn’t need to respond that way? A second question is that my symptoms of reintroducing foods are different than the symptoms I had before I cut them out. For example, my go-to symptom is now very puffy eyes and feeling swollen in my arms, torso, and legs. But that never happened before doing AIP. Does that indicate anything specific?
Thank you!!

And I’m another person who would like an answer to this. I went on the AIP for 30 days because I want to expedite gut healing and look out for potential sensitivities. I have no confirmed autoimmune disease but I do experience mystery ailments such as low energy and random aches.

It seems as though the body would react to certain foods simply as a result of lack of exposure for a while – as an example, both my husband and I had mild gut distress after introducing black pepper, but he isn’t 100% AIP compliant (just mostly). But because he hasn’t eaten pepper in a while, he reacted, and he says he does whenever it’s a particularly strong food that he hasn’t eaten in a while (such as curry), but he is fine if he eats it more often. He has no autoimmune issues, nor any signs, that we know of.

To clarify further: take a Caucasian woman who eats curry for the first time and ends up with a burning you-know-what and multiple bathroom visits (yes, a bit uncouth but it gets the point across ;). Is it that she’s “intolerant”, or that she simply isn’t used to those foods? And after a few exposures, things often improve – much like they do in those who react initially to reintroduction following an elimination diet. How does one tell the difference?

I guess what I’m saying is that it seems to make sense to me that our bodies simply respond more to certain foods than others, not necessarily because we’re intolerant to them. Any thoughts on this?

Thank you for such an interesting and detailed question! While I’m sure that Sarah could explain the difference in more detail in a blog post, I’m going to do my best with it here.

Food sensitivities can be a very tricky topic. If you had a known autoimmune disease, we could point to flare-ups as an indicator that a certain food was giving you a reaction (but I’m not sure what symptoms you were experiencing after consuming the pepper or reintroducing other foods). However, it’s important to consider an annoying fact about human digestion: it’s imperfect, and we might have digestive upset for an assorted number of reasons. I don’t have a good picture of how your husband (or you) are reacting to the black pepper here – did he have an upset stomach, or was it another sign of food intolerance such as breakouts, brain fog, or headaches? Furthermore, if your husband wasn’t following AIP or Paleo at all (is he following Paleo? There are a lot of factors here!), he may not have had the benefit of gut healing; his reaction may be detecting some mild or moderate intestinal permeability (leaky gut). Experimenting with continued reintroductions might give you some more clues; very frequent reactions definitely hints at leaky gut.

Lastly: introducing a completely new food, like having a curry for the first time, is likely to cause digestive upset – their gut hasn’t ever seen this food before! There are yet more factors at play in that scenario (including potential immune reactions that would be on a normal spectrum). Completely novel foods are totally different from foods that have been consumed regularly and are being reintroduced.

Hopefully, this provides some insight!! -Katie, Sarah’s Research Assistant

I have a question about probiotics. I’ve had the feeling for quite awhile that I am making my condition much worse by taking probiotics, but, I keep overriding what I suspect and take them anyway. One thing I have noticed is constipation and fatigue… more burping and nausea. But I have been advised that this means I need MORE, not less, acidophilus, bifida etc. I may have missed an earlier post on this, but would like your thoughts on both taking probiotics orally and things like coconut-based yogurt. Thank you!

Hi,
I read your introduction advices and got worried since some of the symptoms to be aware of when reintoducin foods like: depression, constipation, low of energy and fatigue are what I feel after 15 days of the autoimmune protocol. Is this normal?
Thank you

They can be, but they can also point to some areas that need to be finessed before you start introductions. Are you eating enough vegetables? enough carbs? Are you sleeping well and managing stress? Reintroductions should wait until after you’re feeling good.

My 15 yr old daughter was put on this AIP diet over a year ago by her chiropractor following a diagnosis of hashimoto. She has never been able to reintroduce any new foods. When we started this diet gluten was the only thing that caused sharp head pains. Now anytime she tries a food item that was removed she has those head pains. She is living off of only a couple foods now. Will she ever be able to reintroduce the foods that were removed? Seems like her body has built up a system of attack to everything now.

I was wondering if anyone could advise please. I have relatively high thyroid antibodies and the rest of my hormones are out of sinc. I´v been following the A.I.P. and now after a month on the diet would like to re-introduce foods should my blood test readings improve. The question is, when I do this how would I know I´m damaging myself with food, besides the obvious physicla reactions. ?

thank you so much for this site. I have a lot of resources to help me through this protocol, but I always reference your blog for more support and guidance. I’m only on day 14 of the AIP and I have experienced great changes with, what I think, are secondary symptoms to my primary problem, my gut. I am looking forward to seeing changes in my gut health, and I know it can take up to a year to fully heal… my question is: is it only appropriate to start reintroducing foods after I see my primary issue has gotten better? or can I test foods throughout?

Thanks so much for all of your hard work. I know it has been a long journey for you as well. I am in my 5th month of AIP with no reintroduced foods (I know there has been some things eaten that I didn’t know of beforehand and about died when I found out what they were!) My original autoimmune issues are with myofascial restriction. I have never been tested, just figured it out myself based on massage therapists and research. I also have been eating low FODMAP foods knowing they cause some intestinal issues.
My husband and I are going to Israel next month and really want to reintroduce some things to make it a bit easier. I believe I am also dealing with osteoarthritis in my shoulder, hip, etc which makes me a bit nervous for fear it will be hard to tell of symptoms. What are your thoughts based on what I’ve mentioned here? What would you do?

What is the time frame for symptoms to be evident based on a certain food being consumed? Is it possible to respond immediately, within hours, or can it take your body a couple of days to respond? I plan on starting reintroductions soon and I want to track my reintroductions and any reactions, but I am worried I won’t know if the reaction is from the food or something else.

Hi, I have a question about reintroducing food.
So, let’s say I did reintroduce milk does this mean that I can eat homemade yoğurt and cheese done from milk I reintroduce? Or should I still reintroduce each product separately?
Thank you for your help

Hi. I’ve been on AIP for the last 40 days and would like to reintroduce quinoa soon to my new diet.
After doing the AIP I’m in remission for a UC and I my quit afraid to reintroduce new food since I’m feeling great now.
Should I give it a try since I miss it to much?
Or maybe it’s better to avoid quinoa for some more days?
What abou eggs? I don’t remember ever having a reaction with them but as I said I’m quit afraid at this stage.
Thanks for you help.

My Endo told me that the caffeine is problematic, but I can see the bean issue as well. I recently reintroduced coffee. I still don’t eat any dairy, so I use almond milk in it. I only drink it on occasion, though.

I’ve read your recommendations and procedures for reintroducing foods but have a question. How do you take a nibble of a spice? With spices do you just use them once or twice in a day and then follow the protocol of doing nothing for 3-7 days while monitoring how you feel? Or do you have a different recommendation? Thank you so much for all you do. John

I have a scalp/hair condition that has an autoimmune component. If food bothers me I cannot tell. I have had a basic food allergy test done at the doctor. Nothing turned up. I have been on the autoimmune Paleo diet, strict, for 7 weeks. I see no improvement in the condition, and I feel no different, no better, no worse. (Except I feel more hungry than usual…) I felt fine before. I am also taking a probiotic, multi-vitamin, biotin and now keratin, plus fish oil. My motivation to reintroduce foods prior to symptom relief is the fact that I am throwing a party and I want to enjoy myself, eat the appetizers and have a beer. Is there some science that proves that all autoimmune diseases can be linked to the gut? My motivation to try the diet is there is no cure or known effective treatment and the consequence is permanent scarring and loss. It is all such a mystery…

Hi! I have Grave’s disease which is now in remission! 🙂 I had hair loss issues and it did not stop until my thyroid stimulating hormone was in the normal range. I take biotin and use a biotin shampoo to improve my hair growth. I do not eat beans, dairy, or wheat. (No beer,,,but try Greens…it’s gluten-free) I eat predominately vegetables and fruits as well as fish, chicken, and deer in small amounts. I am sorry that your condition is not improving, but you might want to see if you have a coexisting autoimmune disease as they, too, can cause hair issues. Hashimotos, lupus, psoriasis and a few others also cause scalp issues. Also, try diluted tea tree oil and eat more coconut products to see if that helps! All the best to you!

I have been on the AIP for almost a year, and have just killed off my SIBO about two rounds of herbals (yay!). During the food reintroduction process, any tips for mitigating the symptoms when you do have a bad reaction? I get tired, spacey, headaches- it makes it hard to concentrate at work. Cardio and L-glutamine supplements are helping a bit, but any other suggestions? Thanks so much!

Hi. I feel like this is a stupid question, maybe I am not reading carefully enough. I have been AIP compliant for over a month and am starting to reintroduce foods. I reintroduced green beans and have had no problems. Do stay on beans for a while and introduce snow peas, regular peas, etc.? Or if I have no problem with the one category should I move on to the fruit and berry spices?

When it comes to choosing which foods to reintroduce, there isn’t necessarily a right or wrong way. If you want to reintroduce spices before peas, then go for it! However, Sarah does have a recommended order of reintroduction based on how well certain foods are typically tolerated. And it’s recommended that you stay within a certain stage before moving onto the next, but it’s not required. In your case, beans and peas are in the same stage as fruit and berry spices so either would be fine to reintroduce first. You can read more about reintroduction in Sarah’s free Reintroduction Quick Start Guide. -Kiersten

I followed a strict AIP for a month and then reintroduced hmm well a lot of alcohol (graduation night) and also have been drinking coffee every other day. Have been mostly symptom free (no blood or sever cramping and almost all my joint pain is gone) and had a colonoscopy which showed an almost perfectly healthy colon with colonoscopy recommended in the next 3-5 years. I guess I am confused on what to do next… for example – should I keep taking digestive enzymes? I am definitely keeping the probiotics – been taking renew life – 80 billion 12 strains – 2 in the morning and 3 at night. Should I keep the same quantity, when do you stop taking more probiotics etc. I also drink kombucha daily and take 2-3 T of gelatin… I’m very scared of reintroducing foods although I’ve been drinking a lot lot lot of wine which might be worse but so far so good… It’s hard for me as I also have an eating disorder (recovering from bulimia) so I often overeat on the AIP protocol because I feel very restricted (I don’t eat meat) which I feel stresses my body a lot. Main questions: Would you say that grass fed raw goat cheese is a good food to reintroduce? Also how do I get off the digestive enzymes?

I really think you could benefit from working with one of my consultants. They would be able to give you an individualized plan and help you with reintroductions. You can read their bios at ThePaleoMomConsulting.com.

I am in my 5th week of strictly following the AIP. We went out to dinner tonight and I had a steak, mushrooms, grilled zucchini and salad greens. I told the waitress I could not have many things and we talked about how everything was cooked and I asked for no seasoning, dairy, etc. The food looked and tasted good and I didn’t detect anything that is off limits. However now, 2 hours later I have a horrible stomach ache, am nauseous and sort of wish it would all just come back up since something is clearly causing a reaction. Any thoughts about what the cause could be? Do I need to reset my timetable for reintroduction due to this misstep? And should this happen again, what can I take or do for relief. Thank you.

Some people use activated charcoal after being exposed to something they don’t tolerate, although I don’t personally have any scientific data backing this up. You shouldn’t need to start all over again with AIP, but if you’re in the middle of trying to reintroduce any foods I would start that process over again. -Kiersten

First of all, I want to thank you so much for all the content you post about AIP and Autoimmune Disease! I was diagnosed with Hashimoto’s disease several months ago and have been following AIP to try to feel better. The resources you provide here are invaluable and I am so appreciative.

I am wondering if you had any Hashimoto’s specific reactions that you may have personally experienced for AIP reintroductions. I find that my Hashi’s symptoms were more vague than other diseases (feeling cold, fatigue, brain fog, puffy face, constipation), and I am wondering how to distinguish if it’s the new food giving me these issues or if I maybe am just having an off day.

If I were to be tested by one of the cheap lab testers for allergies to foods, would I still need to eliminate those foods that don’t come back with a negative reaction during the protocol? I’ve just been diagnosed with Hashimotos hypothyroiditus, and my doctor isn’t being of much help. My TPO ab was 88. I simply wanted to know what that meant, and she’s put up a wall since I didn’t want to go on the medication right away. I had to ask for additional testing, just to get the hashimotos’ diagnosis. Initially, it was just my TSH @ 5.64. I’ve been reading more into what could possibly trigger it, and a few months back I had a food borne illness, that really wiped me out. A week prior to that, I had a mercury filling removed, and i didn’t know extra precaution was needed. So two things that could have potentially triggered it, maybe. I don’t know. Everything I know so far, I’ve had to find out on my own, since my doctor is refusing to help in anyway other than prescribing synthroid. :/ (I am looking for a new doctor… but that takes time) Anyway, i’m interested in doing the allergy testing, but don’t know if those foods should still be eliminated.

It seems as though the author is no longer responding. It’s rather inconvenient to those who are actually taking your advice in order to heal.

When you suggest such an extreme diet (and such extreme views, which sometimes contradict themselves), you should be available to clarify your points and answer questions. Many are legitimate, and in the past you have allowed an assistant to reply while you’ve been busy/sick/etc so where are you now?
Some contradictions: your reply to Katharine in 2012, suggesting she introduce tomatoes before potatoes, while in your list you state tomatoes as “the worst”…..and also in other arcticles. For example, in your free reintro quick start, you place egg whites in as group 2, but here and in other places, you suggest that eggs are highly problematic for many people. So why group 2 and not 4? They’re less nutritious than yolks the argument of food value doesn’t fly either).

And your assistant states that nuts aren’t nutrient-dense. That’s the first time I’ve ever heard that one. Granted, they contain phytates, which have some benefits in moderation, but soaked nuts/seeds or even a handful of phytate-rich ones are still quite nutritious. They’re allowed on a Paleo diet and most experts seem to agree that they’re good for us.

If there are inconsistencies, it’s likely because new information is coming out all the time. Tomatoes are one of the most difficult to reintroduce so I would introduce potatoes before tomatoes personally. Egg yolks on their own should be introduced before whole eggs with the whites. Nuts do contain a good deal of nutrients, but they aren’t nutrient dense in comparison to quality meats and vegetables, and that’s likely what Christina meant. And nuts can also be quite problematic for those with autoimmune diseases and/or digestive issues. Hope that clears things up for you. -Kiersten

Hi there- I’ve been on the AIP for 5.5 months, and I havent reintroduced anything yet. I tried switching medication a couple months ago since I was feeling so well (reason for the switch: I needed to be on a safer med in order to have the option to have a baby). Two days into switching meds, my symptoms returned. I’ve been dealing with these symptoms even though I’ve continued the AIP (although they aren’t as severe as 5.5 months ago before I started AIP). I’m planning to switch back to the meds I was on before in the hopes of stabilizing my health.
All this to say, I’m very tempted to “jump ship” with the AIP. I’m going to be traveling this holiday season, and it’d be so much easier to be able to eat out (still gluten free/dairy free as I did before AIP) and not worry about making my own food the entire trip.
What are the risks of leaving the protocol too quickly?

Hello!
I started this year with the idea of introducing foods after two years of AIP. Following the “Quick start guide”, I reintroduced a little amount of egg yolk and waited 15 minutes. Then I ate the rest of the yolk. I felt a little dizzy at first but I didn’t relate it with the egg because that night I didn’t had enough sleep due to work. Three hours later I ate a second yolk. Around two hours later I started to have gastrointestinal symptoms and later headache. It’s been 7 days today and I have had one of the worst weeks since I started with the Paleo Approach. I haven’t been able to sleep well (I wake up in the middle of the night being unable to sleep again no matter how tired I am), I have foggy brain, headaches, extreme exhaustion, IBS symptoms and have a rash in the face… I feel like I am back again where I started a couple of years ago.
This week I been having a lot of kombucha, bone broth and vegetables. I tried some fruit juice, salad or raw food but I am not able to digest it properly. I also have heartburn, something I haven’t had for 2 years…
I was wondering if anyone have had a similar response with the reintroduction and if so, how did you manage to recover and continue with the reintroduction.
Thanks!
Luisa

Is there a way to minimize a reaction as I’m reintroducing things? I have activated charcoal capsules, kombucha & bone broth + collagen powder. Anything else you suggest to calm down gut & joint reaction as I reintroduce things?

need an advice
i have started reintroduction of food and start with egg yolk, and after 3 time he complain stomach pain and i have introduced 10/6/17 and blood test done on 5/7/17 and TSH raise 16.42. whether reintroduction fails can raise TSH level.

Hello, I am reading this because after re introductions I started to gain all the weight I lost while on full AIP. Symptoms wise I am doing great now. I’m planning on going full AIP again but my question is: Is it good to be full AIP for too long, don’t we get too sensitive to foods by being limited for too long? Thanks.

Ideally you will be able to successfully reintroduce at least some non AIP foods after a time doing strict AIP, but remaining strict for longer periods of time shouldn’t be a problem. The thing with doing strict AIP for longer than you need to is that you are potentially missing out on some nutrient dense foods like eggs and nuts. If you’re doing great symptom-wise, my question is why do you feel the need to go strict AIP again?

Hi there! I have Graves disease and Lyme disease and have been following a strict AIP protocol diet for about 9 weeks and feel so much better! I have also started losing weight when the scale wouldn’t budge no matter how hard I tried.

That said. I traveled over the weekend and there were 2 things I ate that I didn’t prepare. We attended an occasion for a friend and I told her I would provide my own food because my diet is so challenging. My friend insisted that they have something for me and she said they would have a pork loin with just salt and pepper. That was the only thing I ate besides some fruit and veggies that I brought for myself.

The next night I spend the night in the bathroom with severe stomach pains and issues. I asked her if they had used any additional spices with the meat and she said “Just salt and pepper. Oh….and veggie paste” She sent the label and it has most things I can’t have. Tomato, modified corn starch, corn oil, paprika and a host of other chemicals and ingredients.

My question is: I was just getting ready to start reintroductions. How long should I wait now that my system has been exposed to this. I have no idea what I reacted to and am guessing I need to continue this strict phase while I try to get everything out of my system.

Today I have a terrible headache, stomach issues, and feel like my brain is foggy again. They said there was only a tsp of that paste in the meat so clearly something is a major issue for me.

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